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Simple Vaginal Trachelectomy in Early-Stage Low-Risk Cervical Cancer: A Pilot Study of 16 Cases and Review of the Literature
  1. Marie Plante, MD*,
  2. Jean Gregoire, MD*,
  3. Marie-Claude Renaud, MD*,
  4. Alexandra Sebastianelli, MD*,
  5. Katherine Grondin, MD, PhD,
  6. Patricia Noel, MD and
  7. Michel Roy, MD*
  1. *Gynecologic Oncology Division,
  2. Department of Pathology, and
  3. Department of Radiology, L’Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Québec, Canada.
  1. Address correspondence and reprint requests to Marie Plante, MD, Gynecologic Oncology Division, L’Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, 11 Côte du Palais, Quebec City, Québec, Canada G1R-2J6. E-mail: marie.plante{at}crhdq.ulaval.ca.

Abstract

Objective This study aimed to evaluate the feasibility of simple vaginal trachelectomy and node assessment in patients with low-risk early-stage cervical cancer (<2 cm).

Methods From May 2007 to November 2012, 16 women with low-risk small-volume cervical cancer underwent a simple vaginal trachelectomy preceded by laparoscopic sentinel node mapping plus or minus pelvic node dissection. Data were collected prospectively in a computerized database. Descriptive statistics and Kaplan-Meyer estimate were used for analysis.

Results Patients’ median age was 30 years and 12 (75%) were nulliparous. Six had a diagnostic cone, 6 had a loop electrocautery excision procedure, 3 had cervical biopsies, and 1 had polyp excision. All patients underwent a preoperative pelvic magnetic resonance imaging. Four patients had stage IA1 with lymph vascular space invasion (LSVI), 6 IA2, and 6 IB1. Ten (62.5%) had squamous lesions, 7 had adenocarcinoma. LVSI was present in 4 cases, suspicious in 2, and absent in 10. There were 2 surgical complications: a trocar site hematoma and a vaginal laceration. The median OR time was 150 minutes (range, 120–180 minutes) and median blood loss was 50 mL (range, 50–150 mL). On final pathology, lymph nodes were negative in all patients. Thirteen (81%) patients had either no residual disease (6) or residual dysplasia only (7) in the trachelectomy specimen. Margins were negative in all cases. With a median follow-up of 27 months (range, 1–65 months), there have been no recurrences. The recurrence-free survival at 24 months is 100%. Eight patients have conceived: 3 were term deliveries and 4 are ongoing.

Conclusions Simple trachelectomy and nodes seems to be a safe alternative in well-selected patients with early-stage low-risk cervical cancer. Our data will need to be confirmed in larger series.

  • Simple trachelectomy
  • Cervical cancer
  • Fertility preservation

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Footnotes

  • The authors declare no conflicts of interest.

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